Simulation-based multidisciplinary team training decreases time to critical operations for trauma patients

Murphy, Margaret; Curtis, Kate; Lam, Mary; Palmer, Cameron S; Hsu, Jeremy; McCloughen, Andrea

doi:10.1016/j.injury.2018.01.009

Cited by 34 publications

(19 citation statements)

References 22 publications

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“…The overall ED LOS increased and there was no reduction in mortality. This prolonged length of stay is likely attributed to an increase in ED presentations without a comparative growth in the hospital’s bed capacity, resulting in ED overcrowding and congestion [8]. Post hoc analysis found LOS in ED was reduced in the cohort requiring critical operations, p < 0.001.…”

Section: Resultsmentioning

confidence: 99%

“…A mixed methods implementation evaluation study was used to obtain a clear and accurate understanding of current trauma practices, processes and outcomes following the original TTT programme. Three methods were used: the influence of TTT on patient outcomes and health service delivery [8], facilitators and enablers to the clinical application of teamwork skills taught in TTT [19] and trauma team members’ experiences and perspectives of teamwork after participating in TTT [20].…”

Section: Methodsmentioning

confidence: 99%

“…Efforts to support teamwork in trauma resuscitation teams include simulation-based team training with a focus on teaching non-technical skills [6]. This training improves the performance of the team in simulation, but there are challenges translating the knowledge into practice [7, 8]. The literature describing the knowledge translation from the simulation training environment into actual clinical practice is scarce [6, 9].…”

Section: Introductionmentioning

confidence: 99%

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Using theories of behaviour change to transition multidisciplinary trauma team training from the training environment to clinical practice

2019

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Background Major trauma patients—such as patients who have experienced road injury, high-impact falls or violence—require complex, intense and rapid resuscitation from a multidisciplinary team of clinicians. These ‘flash teams’ must form quickly and function effectively, often having never met before. There is evidence that multidisciplinary teamwork training improves the performance of the trauma team in simulation. However, the translation of learnt resuscitation teamwork skills from simulation into clinical practice has had modest and variable effects. This paper outlines a method for developing an intervention designed to translate the teaching from a simulated training environment into clinical practice using the theoretical domains framework, behaviour change wheel and behaviour change techniques as the theoretical and empirical basis for the process. Methods The data used to inform the intervention development process were collected during an implementation evaluation study of the trauma team training programme at the busiest level 1 trauma centre in Sydney, Australia. A detailed barrier and enabler assessment were conducted using qualitative and quantitative data. The theoretical domains framework was used to integrate the results. Implementation interventions were selected using the behaviour change wheel. Results Twenty-three facilitators and 19 barriers were identified to influence the implementation of trauma team training in the clinical setting. The facilitators and barriers corresponded to all 14 domains of the theoretical domains framework. Seven intervention functions and four policy categories of the behavioural change wheel were selected to address the target behaviours, and a multimodal relaunch of the revised trauma team training programme was developed. Conclusions This study offers a framework for deductively employing the theoretical domains framework, behaviour change wheel and behaviour change techniques to assess and develop intervention strategies to improve the functioning of trauma resuscitation teams.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using theories of behaviour change to transition multidisciplinary trauma team training from the training environment to clinical practice

2019

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“…In this regard, Schmulz and Eppich (2017) describe the concept of “ team reflexivity ” amongst healthcare teams. They view healthcare teams as groups of well-trained experts that, without dedicated training, often form non-expert teams [ 32 ]. Team reflexivity describes the team’s collective ability to reflect on shared goals, processes, and outcomes of their experiences and adapt accordingly.…”

Section: Discussionmentioning

confidence: 99%

Interdisciplinary clinical debriefing in the emergency department: an observational study of learning topics and outcomes

et al. 2020

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Background Defined as a ‘guided reflective learning conversation’, ‘debriefing’ is most often undertaken in small groups following healthcare simulation training. Clinical debriefing (CD) following experiences in the working environment has the potential to enhance learning and improve performance. Methods Prior to the study, a literature review was completed resulting in a standardised approach to CD that was used for training faculty. A pilot study of CD (n = 10) was then performed to derive a list of discussion topics and optimise the faculty training. The resulting debriefing approach was based on the “S.T.O.P.” structure (Summarise the case; Things that went well; Opportunities for improvement; Points of action). A debriefing aid, with suggested scripting, was provided. A subsequent observational study assessed CD within 1-h of clinical events. ‘Significantly distressing’ or ‘violent’ events were excluded. Data was collected on participant characteristics, discussion topics, and team recommendations. Study forms were non-identifiable. Subsequent analysis was performed by two investigators using content analysis of the debriefing forms (n = 71). Discussion topics (learning points) were coded using a modified version of the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework. One month after completion of the study, ED management staff were surveyed for reports of “harm” as the result of CD. Results During the study period, 71 CDs were recorded with a total of 506 participants. Mean debriefing length was 10.93 min (SD 5.6). Mean attendance was 7.13 (SD 3.3) participants. CD topics discussed were divided into ‘plus’ (well-done) and ‘delta’ (need to improve) groupings. 232 plus domains were recorded of which 195 (84.1%) aligned with the PEARLS debriefing framework, suggesting simulation debriefing skills may be translatable to a clinical setting. Topics discussed outside the PEARLS framework included family issues, patient outcome and environmental factors. CD reports led to preventative interventions for equipment problems and to changes in existing protocols. There were no recorded incidents of participant harm resulting from CD. Conclusions Topics discussed in CD predominantly aligned to those commonly observed in simulation-based medical education. Collective recommendations from CD can be used as evidence for improving existing protocols and models of care.

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“…43 Importantly, these improvements extend to patient outcomes, as simulationbased training is associated with improved outcomes in trauma and cardiac arrest care. 44,45 9. The written MHP should be readily accessible as a reference tool for all team members.…”

Section: Participating Team Membersmentioning

confidence: 99%

A regional massive hemorrhage protocol developed through a modified Delphi technique

Callum

Petrosoniak²,

McVey³

et al. 2019

cmajo

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assive bleeding is a leading preventable cause of death following trauma, childbirth and surgery. 1-3 There were 5.1 million deaths after traumatic injury worldwide in 2010, mostly affecting young people, accounting for nearly 10% of all deaths. 4 In the United States, it is estimated that up to 20% of such deaths are the direct result of preventable hemorrhage. 4-7 Management of unstable hemorrhagic shock is centred on stabilizing the patient with prompt transfusion of blood components, and rapid identification and treatment of the source of bleeding. Patient outcome is dependent on the availability of rapid definitive surgical intervention, support of a transfusion medicine and clinical laboratory, prompt access to hemostatic agents and care provided by a high-performing interdisciplinary team. 8 In the trauma literature, protocolized delivery of massive transfusion streamlines the complexities

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Simulation-based multidisciplinary team training decreases time to critical operations for trauma patients

Cited by 34 publications

References 22 publications

Using theories of behaviour change to transition multidisciplinary trauma team training from the training environment to clinical practice

Using theories of behaviour change to transition multidisciplinary trauma team training from the training environment to clinical practice

Interdisciplinary clinical debriefing in the emergency department: an observational study of learning topics and outcomes

A regional massive hemorrhage protocol developed through a modified Delphi technique

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